Ventricular septal defect

A ventricular septal defect (or VSD) is a defect in the ventricular septum (the wall dividing the left and right ventricles of the heart).

The ventricular septum consists of a muscular (inferior) and membranous portion (superior). The membranous portion (which is close to the atrioventricular node) is most commonly affected.Ambumani P, Kuruchi Srinivasan. Ventricular Septal Defect, General Concepts. eMedicine.com. URL: http://www.emedicine.com/ped/topic2402.htm. Accessed on December 5, 2005.Eidem BW. Ventricular Septal Defect, Muscular. eMedicine.com. URL: http://www.emedicine.com/ped/topic2543.htm. Accessed on April 13, 2006.

Congenital VSDs are collectively the most common congenital heart defect.Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002 Jun 19;39(12):1890-900. PMID 12084585.

Diagnosis

VSDs can be detected by cardiac auscultation, as they typically cause systolic murmurs. Confirmation of findings from cardiac auscultation can be obtained with a cardiac ultrasound (echocardiography) (less invasive) and cardiac catheterization (more invasive).

Auscultation is generally considered sufficient for ruling-out a significant VSD, if done by a pediatric cardiologist.Geva T, Hegesh J, Frand M. Reappraisal of the approach to the child with heart murmurs: is echocardiography mandatory? Int J Cardiol. 1988 Apr;19(1):107-13. PMID 3372064. This holds true as long as the pressures on the right side of the heart is low.

Pathophysiology

Large VSDs result in a significant left-to-right shunt and increase load on the right ventricle. If untreated, they result in hypertrophy of the right ventricle, which ultimately leads to right heart failure and death.

Treatment

Treatment is either surgical (open or percutaneous endovascular) or conservative. Smaller congenital VSDs often close on their own (as the heart grows) and are thus treated conservatively. Open surgical procedures require a heart-lung machine and are done with a median sternotomy. Percutaneous endovascular procedures are less invasive and can be done on a beating heart, but are only suitable for certain patients. Repair of most VSDs is complicated by the fact that the conducting system of the heart is in the immediate vicinity.

Epidemiology

VSDs are the most common congenital cardiac anomalies. They are found in 30% of all newborns with a congenital heart defect, or about 2-3 per 1000 births.

Congenital VSDs are frequently associated with other congenital conditions, such as Down syndrome.Wells GL, Barker SE, Finley SC, Colvin EV, Finley WH. Congenital heart disease in infants with Down's syndrome. South Med J. 1994 Jul;87(7):724-7. PMID 8023205.

A VSD can form a few days after a myocardial infarctionBruckheimer E. Ventricular septal defect. Medical Encyclopedia - MedlinePlus.org, URL: http://www.nlm.nih.gov/medlineplus/ency/article/001099.htm. Accessed on December 5, 2005. (heart attack) due to mechanical tearing of the septal wall, before scar tissue forms, when macrophages start remodeling the dead (heart) tissue.

References

External links

Ventricular septal defect - American Heart Association
Ventricular septal defect - medlineplus.org
Ventricular Septal Defect information from Seattle Children's Hospital Heart Center
Perimembranous VSD - emedicine.com
Supracristal VSD - emedicine.com

Congenital heart disease